Current orthopaedic treatment of ballistic injuries

The purpose of this review is to examine current orthopaedic treatment of gunshot wounds. Surgeons are increasingly confronted by gunshot wounds that occur in both military and civilian settings. Much of the published work has been from military settings. In the United States, low-energy gunshot wounds are very common, and their incidence is increasing elsewhere in the world. Current treatment and its rationale is reviewed and a systematic approach to the assessment and treatment of these injuries is offered, taking into account the entirety of the injury, rather than simply the velocity of the missile.     

Parotid surgery: review of 107 tumors (1990-2002)

Tumors of the parotid gland are uncommon. We performed a retrospective study to analyze the clinical, diagnostic, and therapeutic features of a group of patients. We reviewed the clinical and the surgical records of a series of 109 patients who were recommended for surgery because of parotid tumors by the Plastic and Reconstructive Service of S?o Jo?o Hospital, Portugal, between 1990 and 2002. The following parameters were evaluated: age, sex, gland afflicted, symptoms, and duration of symptoms, diagnostic procedures, treatment methods, follow-up, and recurrences. Pleomorphic adenoma was the most common tumor (63.5%). In the majority of cases, fine-needle aspiration cytology was used. Swelling was the most frequent clinical finding. In 68.2%, superficial parotidectomy was performed. There were five cases of permanent facial palsy, and 10 patients developed Frey's syndrome. Recurrent disease was seen in six patients. For the majority of tumors, superficial parotidectomy is an effective treatment with acceptable morbidity.     

Low calorie commercial sugar is a sensitive marker of glomerular filtration rate

BACKGROUND: Glomerular filtration rate (GFR) in humans and animals might be determined with precision by measuring the clearance of an ideal marker, such as inulin. However, the use of inutest, an inulin analog, is limited by its cost and accessibility. The present study tested whether low calorie commercial sugar (LC sugar) can be used to measure GFR during normal and renal dysfunction. METHODS: Two groups of 6 male Wistar rats weighing 300 to 350 g were included. One group was treated with a daily dose of cyclosporine (CsA) 30 mg/kg subcutaneously for 7 days and the other group was formed by nontreated control rats. In one half of each group, GFR was evaluated by using inutest and in the other half by using LC sugar. GFR was also evaluated by using a wide LC sugar plasma concentration range in an additional group. RESULTS: In nontreated rats, the mean GFR evaluated with LC sugar was 2.2 +/- 0.1 mL/min. This value is equal to that obtained with inutest: 2.3 +/- 0.1 mL/min. CsA administration produced a significant reduction of renal blood flow and renal function. The GFR reduction induced by CsA was similarly determined by both LC sugar and inutest to be at 1.0 +/- 0.2 and 1.1 +/- 0.2 mL/min (P= NS), respectively. In addition, GFR did not change when LC sugar plasma concentration gradually increased. CONCLUSION: Our results show that in both normal and pathophysiologic conditions, LC sugar is a good marker of GFR similar to the gold standard inutest.     

Automated volumetry at CT colonography: a phantom study

RATIONALE AND OBJECTIVES: To assess the performance of a computer-aided detection (CAD) algorithm for measuring polyp-like structures on CT colonography (CTC) images of a phantom. MATERIALS AND METHODS: We constructed a Plexiglas phantom to which we affixed a series of idealized Plexiglas polyp-like objects, including spheres and hemispheres. We imaged the phantom in a four-channel detector CT scanner at a 1.3 mm slice thickness with a reconstruction interval of 0.6 mm, using combinations of 100 mAs, 30 mAs, horizontal and vertical orientation. For each set of CT images, the interior surface of the phantom was segmented. The CAD algorithm was applied to the resulting surface to identify the polypoid regions of interest and to calculate their volume and maximum linear dimension. Calculated values were then compared with actual values to yield percent error in each measurement. RESULTS: The mean error in volume for the subgroups of spheres and hemispheres was 3% and 5% respectively. Mean error in linear dimension was approximately 2% for both shape subgroups. All CAD-calculated values were closely correlated with their respective actual values. Parameter selection did not significantly affect the accuracy of the calculated measurements. CONCLUSIONS: Our CAD software accurately measured the greatest linear dimension and the volume of each of the polyp-like structures in our phantom. Results were largely independent of phantom orientation and the CT exposure factors.     

Use of 3D imaging in CT of the acute trauma patient: impact of a PACS-based software package

To evaluate the impact of a picture archiving and communication systems (PACS)–based software package on the requests for 3D reconstructions of multidetector CT (MDCT) data sets in the emergency radiology of a level 1 trauma center, we reviewed the number and type of physician requests for 3D reconstructions of MDCT data sets for patients admitted after sustaining multiple trauma, during a 12-month period (January 2003–December 2003). During the first 5 months of the study, 3D reconstructions were performed in dedicated workstations located separately from the emergency radiology CT interpretation area. During the last 7 months of the study, reconstructions were performed online by the attending radiologist or resident on duty, using a software package directly incorporated into the PACS workstations. The mean monthly number of 3D reconstructions requested during the two time periods was compared using Students t test. The monthly mean ± SD of 3D reconstructions performed before and after 3D software incorporation into the PACS was 34±7 (95% CI, 10–58) and 132±31 (95% CI, 111–153), respectively. This difference was statistically significant (p<0.0001). In the multiple trauma patient, implementation of PACS-integrated software increases utilization of 3D reconstructions of MDCT data sets.This paper has been accepted for presentation at the 15th Annual Scientific Meeting of the ASER in Montreal, Canada, September 8–11, 2004